Page 49 - Insurance Times June 2019

Circular

IRDAI Circular

To All Insurers and TPAs 7. Insurers and TPAs may capture details of Part – C and
Part – D in Optical Character recognition (OCR) /
Ref. No:IRDA/HLT/REG/CIR/86/05/2019 Machine readable format.
Date:27-05-2019
8. The Insurer and TPAs may specify any additional terms
in Part – D subject to the Service Level Agreement
1. Reference is invited to clause 4 of the Circular ref: IRDA/
entered with the network provider.
TPA/REG/CIR/059/03/2016 dated 28.03.2016 issued
9 This Circular would come into effect from 1st July, 2019
under the provisions of IRDAI (TPA – Health Services)
Regulations, 2016. Annexure 30 of the within referred
circular prescribed three claim forms namely; Part A, DVS Ramesh
Part B and Part C. General Manager (Health)
2. In partial modification of Part C (request for cashless
Guidelines on settlement of Insurance
hospitalization for Health Insurance policy), the revised
“Part C” is herewith specified. Claims of victims of recent Cyclone (Fani)
3. Part D - Cashless Authorization letter Format is now
in Odisha and the neighbouring states
introduced for issuing to the Network Providers at time
of authorizing the cashless treatment. All the Insurers Ref. No:IRDA/LIFE/Odisha & Neighbouring states/
and the TPAs shall ensure that every network provider 2019-20
is notified about the cashless authorization in Part – D
Date:07-05-2019
specified and a copy of Part D is also simultaneously
notified to the policyholder/claimant to enable the
Cyclone Fani has resulted in immense loss to property and
policyholder / claimant have information about the
to some extent lives in Odisha and the neighbouring states.
package rates agreed with the network provider or the
In order to extend every possible facilitation in quick and
extent of authorization issued to the network provider
timely settlement of life insurance claims, you are advised
and related conditions thereof. As and when any
to take the following actions immediately:
supplementary / additional authorization or final
1. Initiate immediate action to ensure that all reported
approval is issued and notified to the network provider,
claims are registered and eligible claims are settled
copy of Part – D shall be also invariably notified to the
policyholder. expeditiously.
4. Insurers and TPAs may endeavor to obtain PART-C from 2. With regard to claims involving loss of life, where
the hospitals by electronic / digital means for seamless difficulty is experienced in obtaining a death certificate
processing of the cashless requests. due to non-recovery of body etc., the process followed
in the case of Chennai floods in 2015 may be considered.
5. Insurers and TPAs may also endeavor to notify Part – D
to the network providers and the policyholders through 3. A suitably simplified process/procedure including
system generated form and may specify accordingly, relaxations in the usual requirements wherever feasible
wherever may be the case. may be considered to expedite claims settlement.
6. All Insurers and TPAs shall ensure that the font size of 4. Details of offices/special camps set up for the purpose may
these forms is not less than Times New Roman 10 and be publicized in the press, electronic media etc to enable
shall be clear and legible. immediate filing of claims. Details of such publicity

The Insurance Times, June 2019 49